Posted
by
timothy
on Thursday February 19, 2015 @10:51AM
from the lord-have-mrsa dept.

puddingebola writes From the article: "A potentially deadly "superbug" resistant to antibiotics has infected seven patients, including two who died, and more than 160 others were exposed at Ronald Reagan UCLA Medical Center through contaminated medical instruments, the hospital revealed. The drug-resistant superbug known as CRE was likely transmitted to the Los Angeles patients by contaminated medical scopes during endoscopic procedures that took place between October 2014 and January 2015, a university statement said. " UCLA says the infections occurred via contaminated endoscopes that were sterilized according to the manufacturer's specifications.
(Note: beware autoplaying video ad; adjust your volume accordingly.)

But, in fact, the system works. Nothing is going to be foolproof or fail safe. There will always be screw ups or just procedures that don't fix everything. However, it is telling that the hospital's surveillance systems figured out what the problem was, identified the patients at risk and presumably stopped the 'outbreak'. 32 patients, although it sounds like a lot, is probably just a couple of days worth of scopes at a big institution.

Although not clearly delineated in TFA, it appears that the problematic instruments were endoscopes used in ERCP [wikipedia.org] procedures. These particular devices [endoscoper...essing.com] are at high risk of contamination due to their complex design.

Tyndallize requires a device to be pressure cooked at 115c for 15 minute sessions, 3 days in a row. Making devices withstand pressure and heat would increase costs quite a bit, plus the cost of having each device out of service for 3 days between uses. Sounds decent enough for simple tools that are mostly metal, but more complex devices, like endoscopes may have issues.

This entire thread is wrong from the very beginning, actual Tyndallization is for things that can't be boiled. You heat it to just below 100C for 15 minutes to kill active bacteria, then you store it in a damp environment for a day to encourage the spores that don't die to germinate into active bacteria and start growing again over the next 24 hours. Then you heat it again. You repeat this every day until you feel you have it clean enough. Any spores that didn't de-cloak will still be there and will bec

Making devices withstand pressure and heat would increase costs quite a bit.

US Healthcare costs are already grossly inflated and the companies charge what they charge because they can get it, not because it's based in reality. I'm trying to find where I read about a medical tool that failed to market because it was priced too cheaply, and was successfully marketed and reintroduced at a higher price point. 2010 cost breakdown [aetna.com] structures and equipment is a fraction of the total expenditure. This is like the drought in California asking residents who use up 14% of the water to conserv

Its not the regulations killing materials costs. Pharmacy costs are pretty obviously the pharmaceutical companies.Materials is a self inflicted wound. multiple hospitals tried to get better pricing by forming GPO companies. A good idea, but somewhere down the line the majority of them wound up in just a few dozen GPOs. Many of those merged and talked them in to long term contracts. Like 99 year contracts. In short order, everyone had to buy through a very small number of middlemen because they can control s

I didn't claim that, my comment about regulations was specific to software. My argument was they charge the prices they do because they can. Costs are passed on. Look at how much insurance charges.

Materials is a self inflicted wound. multiple hospitals tried to get better pricing by forming GPO companies. A good idea, but somewhere down the line the majority of them wound up in just a few dozen GPOs. Many of those merged and talked them in to long term contracts. Like 99 year contracts.

Interesting. Since I'm a cowboy today, why can't these organizations reorg and shirk their contracts? Probably not worth it because the vast majority of overhead typically incurred by an organization is the personnel.

A flexible endoscope is cleaned in a machine more like a kitchen dishwasher than an autoclave. The scope has internal channels for shooting air and water out of a nozzle on the tip. It has a large channel to pass instruments into the patient (biopsy forceps, cauterizers, even other more narrow endoscopes). An ERCP scope has an additional channel that carries a stiff wire that is used to deflect instruments coming out the end. This channel and wire is a very tight fit, so it is more difficult to clean.

Attachments to the channel ports should circulate the sterilizing fluids through all the channels. It's not difficult to imagine a clog preventing the fluid from circulating. Testing for leaks and clogs is part of the cleaning procedure, but in practice, of course, errors happen often:

instead of relying upon shit autoclaves, this wouldn't even be an issue.

I doubt if the problem was the autoclave. It is more likely caused by sloppy procedures by a lazy operator, who didn't cook them long enough, didn't swap gloves between putting stuff in and taking stuff out, or some other dumb shortcut.

UCLA claims they were doing de-con per the manufacturer's recommendations. They've changed it now, which is encouraging. But had they gone off book from the start, they'd be just as liable to infect people for NOT following instructions.

Had they gone off-book from the start, they might have been liable for problems. Since they can demonstrate problems from going according to the book, they're a lot safer legally in coming up with a new procedure.

You're joking, right? Many of the slashdotters who dedicate themselves to blaming everything wrong in the world on Obama barely even know who Putin is. The likelihood that they would blame anything on him is quite nearly zero, especially as the official slashdot narrative remains that Obama is a closet communist/fascist/Islamist/anarchist/socialist/martian/illuminati who is femtoseconds from launching a new plan for world domination.

Obviously you never even actually watched Fox (which really had nothing to do with this conversation) because they've talked about Putin and the Ukraine situation quite a bit, actually. 10 years ago, everything was Bush's fault, now it's Obama's fault. Seems fair.

I thought the main misfortune of Obama is that he was born in Liberia, or was it Haiti?

There is no shortage of birthers out there who are still dedicated to "answering" that question.

However, based on what many slashdot conservatives write, it appears that Obama's biggest failure is in the fact that he has the wrong consonant after his last name. His actual decisions and policies are demonstrably more conservative than their hero Reagan but he happens to be a democrat so he is automatically the antichrist.

flexible endoscopes have been around since the 1960's, and they cannot go through an autoclave. Rigid endoscopes can go through an autoclave, but they are more limited in application.

Maybe a camera endoscope could be designed to last in an autoclave, if you can make one you should patent it and demands the FDA no longer approve older designs as they are difficult to sterilized and have literally killed people already.

From January 9, 2014...This investigation highlights the potential for CRE transmission following ERCP. Health-care facilities with CRE outbreaks should consider the possibility of ERCP-related transmission. If ERCP-related transmission of CRE is suspected, reprocessing and preventative maintenance procedures for ERCP endoscopes should be evaluated in consultation with the manufacturer of the endoscope and automated endoscope reprocessor, if used. In addition, expertise in the evaluation and prevention of CRE transmission are available at CDC and can be accessed via state and local health departments.http://www.infectioncontroltod... [infectionc...ltoday.com]

Sheldon Cooper: To a hospital? Full of sick people? Oh, I don't think so.

Penny: Okay, well, your friend and his mother are there. We're going!

Sheldon Cooper: I can't.

Penny: Oh, don't tell me you're afraid of germs.

Sheldon Cooper: Not all germs. Just the ones that will kill me. The same way I'm not afraid of all steak knives; just the ones that might be plunged in my thorax.

Leonard Hofstadter: Ah-uh, fine, I'll tell Howard you didn't come because you're more concerned about your own well-being than his.

Sheldon Cooper: I would think he would know that.

Penny: Okay, you know what? You are unbelievable. You buy all these superhero T-shirts but when it's time for you to step up and do the right thing, you just hide in the laundry room.

Sheldon Cooper: Fine, I'll go. Just for the record, my Aunt Ruth died in a hospital. She went in to visit my Uncle Roger, caught something, and bit the dust a week later. The two of them now share a coffee can on my mother's mantel.

It is in large part because the actors add a lot more to the performance than just the recitation of lines. That aside if you can't see the humor in a holier than though know it all being called out on his own personal cowardice then it might follow that you are possesed of the same flaws as Sheldon's character.

Visiting a friend in a hospital though is not like sitting around in a doctor's waiting room. Most of a modern hospital's patients aren't infected with some infectious disease. Patients are typically kept in rooms by themselves or with one other patient. There is also a lot of effort that goes into trying to keep it a relatively sterile environment. The only area of a hospital that you could accurately equate to a waiting room in a doctors office would be the emergency room, which if you are going there to

It has always baffled me that Americans use anti-bacterial soap. I have never even heard of it being used here in Sweden. At hospitals and other sensitive areas we use regular soap plus rubbing alcohol.

Acid, chlorine, etc. all kill bacteria in ways that are unlikely to result in resistant strains.The compounds in anti-bacterial soap (triclosan for example) are not used to treat internalinfections. Antibiotics are more specalized compounds which target bacteria and are (relatively) harmless to humans.The problem (if there is one) with anti-bacterial soap seems to be that a certain amount of exposure tobacteria is apparently good for the human immune system and widespread use of anti-bacterial compoundswork

I'm seriously regretting any anti-bacterial soap I've used over the years right about now.

I'm regretting the anti-bacterial soap that every moron is using, the evil marketers that tout it as a feature, and the greedy companies that capitalize on people's fear of mostly harmless bacteria.

In case anyone is wondering, one of the best antibacterials is other bacteria, but on the other hand, there are bacteria specialized in surviving in hospital environments including both antibiotics and chemical cleaners. So not only do these soaps train antibiotic resistance in bacteria, but they also clear the w

I'm seriously regretting any anti-bacterial soap I've used over the years right about now.

Don't be. We may breed triclosan-resistant bacteria by using antibacterial soap, but that doesn't mean we're breeding carbapenem-resistant bacteria -- the C in CRE -- by using triclosan. There is very little evidence that developed resistance to one type of antibiotic increases resistance to another completely unrelated antibiotic. Triclosan inhibits fatty acid synthesis, carbapenem inhibits synthesis of the peptidoglycans used in bacterial cell walls.

Wrong. Clearly this isn't your field, so generally speaking, please stop commenting with an authoritative tone on things where you do not have the expertise or the will/ability to think through it.

Increased mutation rates and adaptability of bacteria appear to be significant factors for development of antibiotic resistance and are selected for passage to the next generation through natural selection.

On the other side, I'll bet the hospital expects the patients to pay the full bill, including the bill for treatment (successful or not) for the disease the hospital gave them. It's no wonder people are so quick to sue.

Ahh, EndoscopePass me the tube so I can take a poke1 push, 2 push, 3 push, 4 push, 5 I'm feelin deep insideLeaning to the side in my Ophthalmic rideWith the KY gangsta glideWoo!, hey now ya knowInhale, exhale with my flowBreakaway, come again like thisHey G promise me use two hands don't missCuz if you do, it break you get brokeMe and Mista G and the endoscope

If they were cleaned per the Manufacturer's specs (which feels a little like the fox cleaning the hen house) then said company should be fined into oblivion and all involved with writing and approving said procedures held in gaol for quite some time.

Most of that is stuff that would have happened regardless of who was President. Reagan (and Bush 1) also ballooned the national debt from about $908 billion in 1980 (32.5% of GDP) to $3,233 in 1990 (54.4% of GDP).

I seriously doubt that he had anything to do with freeing me from tyranny. These were my fellow citizens who kicked the collective ass of communist party plus communist parties themselves by running their economies to the ground and seeing everything as danger to communist ideals thus suffocating all non-governemnt initiated activity except resistance. He happened to be just at the right spot to take the glory.
US were sick when he took office. I am not sure they recovered all that much unless of course yo

Literally the only reason we are doing this is because the democrats are running out of US citizens that actually want to vote for them. So they're importing voters and pretty much breaking every rule on the books to do it. I'm not saying that if you're a democrat that you're a scummy person. You're probably my neighbor and I'm not mad at you. But the people pushing this at a high level are scummy people. They're used to buying elections and since that isn't working as well as it used to they're importing voters. Its pretty disgraceful.

[facepalm]Oh good God! [/facepalm] If non-citizens are voting in any significant numbers how hard can that be to prove? The Bush II administration made it a point of emphasis with the US Attorneys and they didn't find much. Instead we have Republicans pushing voter ID laws that fall most heavily on low income citizens (legal voters) who otherwise have no need for that kind of ID. They're desperate because they know the demographics are turning against them.

Voter ID laws are about much more than illegals. In the last presidential contest, Romney get not one vote from 59 voting divisions in Philadelphia. Not one single vote. 19,605 to zero. Same with 9 precincts in Cleveland. Many of these voters are not even literate. This is a statistical impossibility. St. Lucie County in FLA had 141% voter turnout. Without fraud like that, the election might have had a different outcome.

It would help to actually do some research as to how it was probable that Romney would get 0 votes in these 59 districts.

First, who said they won't be citizens? If you make anyone that crosses the border a citizen then they can vote.

What evidence do you have that is happening? It takes far more than crossing the border to become a citizen of the US (unless you are born here of course).

If the democrats really didn't want illegals to vote then they'd allow for some investigation of the voter roles.

The voter registration lists are a matter of public record. It's not that hard to get them. [google.com] Don't you think that by now if illegals were being allowed to vote someone would have got a list and audited it and blown the lid off that scam?

As to evidence... I am apparently talking to someone that doesn't read the news.

Type "Obama Amnesty Judge" into your search engine of choice. You'll get a whole page of links referring to Obama's bs being so completely out of control that the US Judiciary is putting the brakes on it. Which is f'ing impressive because they rarely involve themselves in such matters unless the government goes WAY beyond its authority.

As to auditing voter registration lists, they are audited but not by the government. They're a

As to evidence... I am apparently talking to someone that doesn't read the news.

Type "Obama Amnesty Judge" into your search engine of choice. You'll get a whole page of links referring to Obama's bs being so completely out of control that the US Judiciary is putting the brakes on it. Which is f'ing impressive because they rarely involve themselves in such matters unless the government goes WAY beyond its authority.

Where in all of that do you get that anyone is granting citizenship to any of them? Amnesty from deportation is not tantamount to granting citizenship. In a situation where resources are limited the President has discretion to direct the funds to where he thinks they'll do the most good. Did you know that Obama has deported more people than Bush did before him?

As to auditing voter registration lists, they are audited but not by the government. They're audited by private citizens and they do find fun names on their like "Mickey Mouse" or dead people that have been voting some how for years.

Evidence? Without that you're just making unsubstantiated accusations. I agree that there are dead people on the voter rolls that should be purg

First, they were talking about granting citizenship to people in mass. Numbers ranged from 200,000 to 5,000,000. That is why the courts put the stop to it. From the perspective of the courts, Obama has the right to not enforce the law which just shows you how flexible the courts are on the matter. However, he was going beyond that to grant citizenship to people in contradiction of the law. Which is why the courts shut it down.

Second, even in the event that citizenship would not be issued, he was talking abo

Having a social security number has nothing to do with citizenship. Anyone who works legally in the US is eligible for a SSN. All of the non-citizens who are in the country legally working with a green card have SSNs. As an example I specifically know about, Nicolas Batum, a French citizen who plays for the Portland Trailblazers has a social security number. Another example would be a coworker of mine. He is originally from South Africa but found his wife in the US. He became a citizen about 6 years a

The government has already confirmed that it is possible. You're basically saying the federal government is wrong. And given that the federal government is the last word on that issue... your point is beyond pointless.

I didn't say anything about not requiring some form of ID when you register to vote.

I'll believe that ID should be required to vote when someone demonstrates there is any amount of voter fraud that presenting such an ID prevent. No one has been able to do that even though it was a point of emphasis for the Bush II US Attorneys. So it's the epitome of an unnecessary law to require such an ID for voting.

At least around here, we keep public records of who showed up and voted. Somebody could check out anybody thought suspicious, and somebody caught having voted without the legal right would be guilty of a fairly serious crime. There has been some inter-party rancor, and accusations of vote fraud brought up without real evidence. The Franken-Coleman senatorial election was exceedingly close, but all the arguing was about counting the ballots, not vote fraud.

If I'm protecting systemic voter fraud, show me the goddam fraud! That's what I'm asking. Show me some significant fraud that ID cards would have prevented, if you want to convince me.

If you can't point to some fraud that ID cards would have prevented, why should I be in favor of voter ID? Not everybody has a driver's license, and getting an ID can be awkward for someone in the wrong neighborhood.

And, again, unless you can show me some fraud, you have no case and your position on this matter is fait

Show me when a person clearly over 18 can possibly not be entitled to buy alchohol?

Half the reason the evidence is often scanty is that there is no investigation and no mechanism in place to investigate it.

An example of something similar would be that in Japan unsolved murders are often cited as "accidental deaths" even when they were clearly murders. The reason being that it looks better on the crime statistics. It is a big problem in Japan to have unsolved murders. It is also partially why their suicide r